TITLE 19/NON-TITLE 19 (TITLE XIX/Non-Title XIX)
A person who meets certain income requirements can qualify for the public behavioral-health system and is called a "Title 19" client. Someone who does not is referred to as "non-Title 19."
This includes mental health, mental illness and substance abuse.
SERIOUS MENTAL ILLNESS
This is when a person's emotions or behaviors, because of a mental disorder, are so affected that he or she has a hard time living day to day without ongoing support and treatment. It has a long-term impact on the person's relationships, employment and ability to get along with others, and makes it harder to function in other aspects of life.
The term generally applies to persons age 18 or older, but research has shown some serious mental illnesses begin before that. Disorders such as bipolar disorder, schizophrenia and some types of depression are considered serious mental illnesses.
CPSA's Comprehensive Service Providers or SAMHC can make an official determination of serious mental illness that means the person is eligible for some publicly funded services.
MEDICAL V. LEGAL COMPETENCE
Assessing a person's mental competency means different things in different venues.
In the medical or psychiatric arena - such as determining if a person with a serious mental illness should be hospitalized, even against his will - the measure is if the person is a danger to self or others, persistently or acutely disabled or gravely disabled.
These are civil actions involving the court. Terms such as "civil commitment petitions," "Title 36," "pre-petition hearing" and "emergency petition" are all part of the process that allows a person with a mental illness to be hospitalized if a judge, relying on expert and witness testimony, decides it's in the person's best interest.
That's different than determining competency in the context of a criminal proceeding. "Rule 11" is shorthand for the need to figure out if a person who has been charged with a crime has the ability to understand the charge and the trial process and can assist his defense attorney.
After a person is evaluated under Rule 11, a judge must decide if the person is competent (which does not mean the person is not mentally ill), incompetent but restorable (with psychiatric medication or other treatment the person can be made to understand and assist in his own defense), or incompetent and not restorable. This last category means the person cannot legally be tried for a crime, because he is not now and never will be in a mental condition to understand the legal system and assist in his defense. When that happens, if the person is diagnosed as having a serious mental illness, he may end up being civilly committed to a hospital under Title 36. If the incompetency is caused by brain damage, for example, he will be released from jail but not necessarily hospitalized.
INVOLUNTARY COMMITMENT/ HOSPITALIZATION
A person must be found by a court, relying on psychiatric professionals, to be a danger to himself or others, "gravely disabled" or "persistently or acutely disabled" before he can be hospitalized for court-ordered evaluation.
COURT ORDERS FOR MENTAL-HEALTH EVALUATION AND TREATMENT/TITLE 36/EMERGENCY PETITION/CIVIL COMMITMENT
In the Tucson area, seeking a court-ordered psychiatric assessment starts with a call to the 24-hour Community-Wide Crisis Line at 622-6000 or 1-800-796-6762. Any responsible person may apply for a court-ordered evaluation of a person who isn't willing or able to be evaluated voluntarily.
Crisis Response Center or SAMHC staff members help people through the process, which varies based on whether the need is urgent.
An application for emergency admission for evaluation is used when the person in need of evaluation is a danger to self and/or others and requires immediate hospitalization. When the patient arrives at the emergency department, he is examined by a psychiatrist who determines whether emergency admission is necessary. If the patient is admitted on the emergency application, he will be further evaluated over the next 24 hours (excluding holidays and weekends). The evaluating psychiatrist will decide whether the patient requires court-ordered evaluation.
The hearing could result in a court order for treatment, which typically involves a hospital stay until the person is stabilized, followed by outpatient care. If the person doesn't comply with outpatient treatment - by not taking medication, for example - the court can order him back into the hospital, if other less-restrictive solutions are not appropriate
The court order, which is good for one year, includes a certain number of days available for inpatient treatment. Those periods differ depending on whether the person is deemed a danger to themselves (90 days), to others (180 days), "persistently and acutely disabled" (180 days) or "gravely disabled" (365 days).
Calls can be made anonymously to a crisis line to report concerns about someone's mental health. However, people who make formal petitions to the court are identified once the case is in the legal system.
If a person needs immediate evaluation because he might be a danger to himself or others, call 911.
DANGER TO SELF OR OTHERS
Under Arizona law (A.R.S. 36-501), a person is considered a "danger to others" if a mental disorder affects his judgment so much that he can't understand that he needs treatment, and if the person continues to go without treatment it "can reasonably be expected" (based on medical opinion) to result in "serious physical harm."
A person with a mental disorder is considered a "danger to self" if:
• She has attempted or makes a serious threat of suicide.
• Given her history and the circumstances, the threat seems likely to be carried out.
• She needs to be hospitalized to prevent serious harm or serious illness.
"Gravely disabled" means a person is likely to experience serious physical harm or serious illness because he is unable to provide for his own basic physical needs. Being unable to provide yourself a place to live or being homeless may be an indication of grave disability, but on its own does not mean a person is a "danger to self" under the law.
According to the law, "persistently or acutely disabled" means having a severe mental disorder that meets all the following criteria:
• If not treated has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional or physical harm that significantly impairs judgment, reason, behavior or the capacity to recognize reality.
• Substantially impairs the person's capacity to make an informed decision regarding treatment, and the impairment keeps him from understanding and expressing understanding of the pros and cons of accepting treatment and alternatives to the specific treatment offered after the pros, cons and alternatives are explained to him.
• Has a reasonable prospect of being treatable by outpatient, inpatient or combined inpatient and outpatient treatment.
DECOMPENSATE (OR "DECOMP")
"Decompensate" describes what happens when the condition of a person with mental illness who has been stable and functional, often on medication or other therapies, deteriorates and the person shows worsening symptoms of his illness. A decompensating person is likely to end up in a mental illness crisis if he's unable to get treatment.
RBHA (PRONOUNCED 'REEBA')
Arizona is divided up into geographical areas, and a Regional Behavioral Health Authority, or RBHA, is the agency the state puts in charge of managing services for people who live in that area and qualify for public services. In Pima County, the RBHA is Community Partnership of Southern Arizona, or CPSA.
A Tribal Regional Behavioral Health Authority (TRBHA) does the same thing for eligible people who are residents of a tribal nation, like Pascua Yaqui. Members of the Tohono O'odham Nation do not have a TRBHA and are served by CPSA.
CRISIS INTERVENTION TEAM TRAINING (CIT)
This trains law enforcement officers to help them identify when mental illness could be involved in a police call, defuse potentially dangerous situations and keep all parties safe.
Recovery begins as soon as a mental illness is diagnosed and continues as the person's illness is managed. Education, support and, in some cases, medication help the person be responsible for his or her own progress. It includes overall health and wellness, relationships and opportunities to hold a job, help others with a mental illness and/or be active in the community.
How to help yourself or someone else
As others have said, if you see someone having a heart attack on the sidewalk you'd not hesitate to call 911 for help. But if someone is visibly agitated or displaying signs of mental illness, we aren't so quick to act - or to know what to do.